The importance of catastrophizing for successful pharmacological treatment of peripheral neuropathic pain

Figures & data

Table 1 Coping strategies questionnaire catastrophizing subscale items

5. It is terrible and I feel it is never going to get any better.

11. It is awful and I feel it overwhelms me.

25. I worry all the time about whether it will end.

33. I feel I can’t stand it anymore.

Using a 7-point Likert scale for each item, subjects were asked to self-report how often they used that strategy when they experienced pain, where 0= never, 3= sometimes, and 6= always.

Note: Adapted from The Coping Strategies Questionnaire catastrophizing subscale Rosenstiel and Keefe.¹⁷ Adapted with permission from Dr Francis Keefe.

Figure 1 The CONSORT flow diagram for patients evaluated in this study.

Abbreviations: BDI, Beck Depression Inventory; CSQ, Coping Strategies Questionnaire; EQ-5D, European Quality of Life 5 Domains; KPS, Karnofsky Performance Scales; mBPI, modified Brief Pain Inventory short form; MOSSS, Medical Outcomes Study Sleep Scale; PGIC, Patient Global Impression of Change; VAS, visual analog scale.

Table 2 Patient characteristics for all patients enrolled to determine catastrophizing or coping skills

	Patient characteristics (n=62)
Sex: females (%)	36 (58%)
Age (years [range])	51.9±7.2 [34–86]
Duration of NeP (years)	6.7±3.4 [1.5–7.8]
Number of pain medications previously failed	1.6±1.2 [0–4]
Diagnosis
Diabetic polyneuropathy	27
Idiopathic polyneuropathy	22
Vitamin deficiency polyneuropathy	5
Polyneuropathy associated with monoclonal gammopathy	4
Inflammatory polyneuropathy	2
Vasculitic polyneuropathy	1
Hereditary polyneuropathy	1

Notes: Values expressed are means ± standard deviations, with numbers in square brackets representing range of values and numbers in rounded brackets representing percentages.

Table 3 Medication interventions provided to patients

	Number of patients receiving specific medication	Initial medication daily dose	Final medication daily dose	Discontinuations
Amitryptyline	25 (40%)	15.0±5.2 mg	37.3±12.7 mg	14/25 (56%)
Nortryptyline	10 (16%)	25.5±11.3 mg	55.7±13.3 mg	5/10 (50%)
Gabapentin	17 (27%)	667.0±112.3 mg	1,562.7±147.8 mg	7/17 (41%)
Pregabalin	10 (16%)	120.5±62.3 mg	363.3±78.8 mg	4/10 (40%)

Note: Values expressed are means ± standard deviations, with numbers in rounded brackets representing percentages.

Figure 2 Correlational analyses for the Coping Strategies Questionnaire (CSQ) catastrophizing subscale score are demonstrated.

Notes: The change in the primary outcome measure pain severity score (evaluated using the visual analog scale [VAS]) had a positive relationship with CSQ catastrophizing subscale scores, with a negative change in the VAS reflecting improvement in pain severity (A) (Spearman’s rho, P<0.05). The presence of medication discontinuation by final endpoint was associated with significantly greater CSQ catastrophizing subscale scores (see Table 5) (B). There were negative significant relationships for CSQ catastrophizing subscale scores with both of the EuroQol Quality of Life – 5 Domains (EQ-5D) Index Score (C) (Spearman rho, P<0.05) and for the Karnofsky Performance Scale (D) (Spearman rho, P<0.05). R² values for each correlational analysis are provided on each subfigure. In subfigure 2B, horizontal lines indicate average values for the CSQ catastrophizing subscale scores for each subgroup, with numbers provided demonstrating averages ± standard errors.

Table 4 Coping strategies questionnaire subscale results

Measure	Baseline scores (n=66)	3-month scores (n=62)	6-month scores (n=58)
Diverting attention (/36)	11.9±6.2 [4,36] (13)	11.5±5.8 [4,36] (12)	11.3±5.9 [4,36] (12)
Reinterpret pain sensations (/36)	6.4±4.8 [2,22] (8)	6.7±4.5 [2,21] (8)	6.6±4.6 [2,22] (8)
Coping self-statements (/36)	20.3±7.6 [3,36] (19)	20.8±7.2 [4,36] (20)	20.5±8.0 [4,36] (20)
Ignore pain sensations (/36)	16.8±7.3 [3,30] (18)	16.5±6.5 [3,28] (17)	15.8±5.7 [3,29] (16)
Praying or hoping (/36)	10.9±6.0 [0,35] (9)	10.7±5.7 [0,36] (10)	10.8±5.9 [0,36] (10)
Catastrophizing (/36)	15.5±7.0 [2,36] (15)	15.3±6.7 [3,36] (15)	15.4±6.5 [2,36] (15)
Increase activity level (/36)	17.3±7.4 [4,36] (17)	16.9±6.5 [5,36] (18)	15.9±5.4 [6,36] (17)
Control over pain (/36)	3.9±2.2 [0,20] (5)	3.6±2.0 [0,22] (5)	3.5±2.0 [0,22] (5)
Ability to decrease pain (/36)	2.9±1.8 [0,18] (4)	2.7±1.7 [0,22] (4)	3.1±1.9 [0,22] (4)

Notes: Values expressed are means ± standard deviations, with numbers in square brackets representing the range of values and numbers in rounded brackets representing the median. Scores for each subscale are out of a total of 36 possible points.

Table 5 There were significant correlations between the catastrophizing subscale score of the coping strategies questionnaire and with medication discontinuance and medication success

Factor	Measure	Factor	1	2	3	4	5
		Mean ± SD
1	VAS pain intensity	61.1±8.8
2	EQ-5D disability index score	0.62±0.11	−0.22^a
3	Catastrophizing subscale score of the Coping Strategies Questionnaire (/36)	15.5±7.0	−0.17	0.30^a
4	Medication continuance	32/62 (52%)	0.08	0.15	−0.36^a
5	Medication success	21/62 (34%)	0.13	0.11	−0.34^a	0.54^a
6	Karnofsky Performance Scales	77.6±9.7	−0.23	0.21	−0.34^a	0.12	0.13

Notes: Secondary outcome measures of interest ([EQ-5D] and Karnofsky Performance Scale) also possessed significant relationships (^aP<0.05, Pearson product-moment correlations). Values expressed are means ± standard deviations (SD) and represent data obtained at the 6-month follow-up visit in the third column. Remaining columns present the r value for correlation.

Abbreviations: EQ-5D, European Quality of Life 5 Domains; VAS, visual analog scale.

Figure 3 Patient global impression of change (PGIC) was reported at the 6-month time-point, demonstrating significantly less perceived benefit for scores obtained from “high” catastrophizers (A) as compared to “low” catastrophizers (C) (modified ridit transformation with the Cochran–Mantel–Haenszel procedure, adjusting for center, *P<0.05), with “medium” catastrophizers shown in (B). There were no significant differences between “high” and “medium” catastrophizers, or between “low” and “medium” catastrophizers.

RosenstielAKKeefeFJThe use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustmentPain198317133446226916

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